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Arthritis Treatment – Pain Management


Arthritis Treatment – Pain Management

Patient education is an important component and first step in Arthritis Treatment (Pain Management).


Cognitive Behavioral Therapy:

arthritis treatmentCognitive Behavioral Therapy (CBT) interventions can assist in management of pain and disability. CBT is used to reduce pain and psychological disability and to enhance self-efficacy and pain coping. Strategies includes cognitive-coping skills, distraction, mental imagery, cognitive restructuring, activity-pacing methods, pleasant activity scheduling, goal setting, relaxation based skills, stress management, and relapse prevention methods. CBT enhances, rather than replaces, other medical therapies.


Weight Management:

Weight management should be an integral part of patient education and involves improving awareness of the relationship between healthy body weight and improvement in symptoms of arthritis. Restricted calorie intake, dietary supplements, and nutritional education should be provided. The guidelines recommend that patients with arthritis maintain a body mass index (BMI) of <30, and those above this level should follow a weight management program.


Physical Activity:

Increase in physical activity should be encouraged by participating in moderate intensity physical activity at least 3-4 times a week as recommended by the US Surgeon General. In Wisconsin, among adults with arthritis, approximately 27% are physically inactive as compared to 19% of those without arthritis.If this is not possible for the patient due to medical or pain issues, it is recommended that a referral to a physical or occupational therapist be considered to evaluate and provide a specific activity and exercise program for each patient. This includes range of motion, flexibility, muscle strengthening, and aerobic conditioning exercises.


Pharmacological Management:

Pharmacological management should be used in conjunction with nutritional, physical, educational, and cognitive behavioral treatments.


Physical Modalities:

Physical modalities are also useful nonpharmacolgical approaches to manage pain. Heat produces analgesia, relaxation, reduces muscle spasm, and enhances flexibility of soft tissues. Cold produces analgesia and reduces inflammatory response. Electrotherapy in the form of transcutaneous electrical nerve stimulation may reduce pain and increase function, especially if there is a neuropathic component to the pain.


Orthotic Devices:

A variety of orthotic devices are available to provide rest and stability, and can decrease pain of affected joints. These include hand splints, shoe supports, and functional orthotics. Additionally, when stability and safety of ambulation becomes impaired, a variety of assistive devices such as canes, crutches, walkers, and wheelchairs can maximize mobility in a safe and independent manner.


Alternative Medicine:

There has been considerable interest in complementary and alternative medicine approaches for arthritis treatment. Many of these are not regulated by the FDA and few evidence-based studies are available to demonstrate their effectiveness. Patients using 1500 mg of oral glucosamine sulphate in a placebo-controlled double blind study demonstrated improvement in pain and physical functioning. There is no evidence to support magnet therapy or copper bracelets in treatment of pain associated with arthritis.



Surgery should be considered when pain and functional limitation prevent the minimum amount of activity recommended, especially in obese older people. For optimal functional results, people with disabling arthritis should be referred for surgical care prior to the onset of joint contracture, severe deformity, advanced muscular wasting, and deconditioning.

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